DME Update 05/01/08
A7507 reimbursement has been increased to $2.49 effective 5/1/08.
B4082 has been added with reimbursement of $14.73 with no PA required.
A6506 Compression burn garment glove to axilla, custom fabricated has been added with PA required and manual pricing.
A4483 Moisture exchanger, disposable, for use with invasive mechanical ventilation has been added to the fee schedule. PA required with manual pricing.
A7520 reimbursement will be increased to $47.48 effective 5/1/08.
Phenex 2 has been added to the fee schedule with PA required and a reimbursement of $43.68 per 400-gm. can. Please use B4162 for pediatric and B4157 for adult use.
Phenex 1 should be coded with B4162 for pediatrics and B4157 for adult use. These have been verified on the Abbott website.
DME Update 04/01/08
L3702 has been added to the fee schedule with PA required and manual pricing.
Benecalorie coded under B4155 has been added to the fee schedule with PA required and reimbursement at $1.47 per can.
The reimbursement rules for E0952 have been entered and claims should pay correctly.
A6543 has been added to the fee schedule with PA required and manual pricing.
E0849 has been added to the fee schedule with PA required and manual pricing.
Reimbursement for Traumacal has been changed to $2.62 per can effective 4-1-08.
K0672 has been added to the fee schedule effective 4-1-08 with PA required and manual pricing.
DME Update 03/01/08
A4211 Supplies for self-administered injections is to be used for pen needles. Please request in quantities of 1 box of 100 needles = 1 unit. Manual pricing and prior authorization applies.
K0006 and K0007 wheelchairs:
It has been the policy of KY Medicaid when a prior authorization for a K0006 or K0007 wheelchair is requested to require a PT evaluation. These chairs are suitable for a person weighing 250+ pounds.
To require a PT evaluation for members who weigh 250+ pounds could be considered discrimination based on the weight of the member. For this weight range, the K0006 and K0007 manual wheelchairs should be considered a standard wheelchair and a PT evaluation will not be required. Prior authorization will continue to be required for these codes.
The wording of 907 KAR 1:479 Section 4 (3) (b) will be clarified with the next regulation revision.
This is effective for Dates of Service 1-1-08 and after.
CMS has activated K0672, addition to lower extremity orthosis, removable soft interface, all components, replacement only, each. This is effective 4-1-08. This code requires a PA and is manually priced.
DME Update 02/06/08
A4402 should be billed as 1 oz. =1 unit. There is a limit of 4 units per calendar month. Over the limit requires a prior authorization. The pricing on the fee schedule reflects the payment per 1 oz.
DME Update 02/01/08
K0606 has been added to the fee schedule as a rental only with a reimbursement of $2,268.20 monthly. Prior authorization is required.
Prior authorization has been removed effective 1/15/08 for the following codes: A7044, L3925, L3929 and L3931. Necessary system change has been made.
Quantity pricing clarification: Vital High Nitrogen is priced 6/packets per carton.
K0669 is to be used for wheelchair accessory- wheelchair seat or back cushions when the item does not meet specific code criteria or no written coding verification from SADMERC. Please see the 2008 HCPCS Level II book.
Mic-Key G-Tubes:
Use E1399 with manual pricing to dispense a kit. The invoice must indicate that it is a kit and you must be able to provide the contents of the kit upon request by SHPS. The Kimberly-Clark kit consists of the tube, extension set with secur-lok right angle connector and two port Y, one bolus ext set with cath tip, secur-lok straight connector, one 35-ml. catheter tip syringe, one 6-ml. luer slip syringe and four gauze pads. Additional extension sets would not be authorized at the time the kit is approved without justification.
The kit contents must be complete from the manufacturer and not assembled in your office.
B4088 refers to the tube only and would be subject to the current pricing as CMS has set a rate for Kentucky for that code.
Quantity change for L8020 and L8030-PA required for greater than two per year.
DME Update 01/01/08
Codes added:
A4252, A5083, A7027, A7028, A7029, B4087, B4088, E2227, E2228, E2312, E2313, E2397, L3925, L3927, L3929, L3931, L7611, L7612, L7613, L7614, L7621, and L7622.
Codes deleted:
B4086, E2618, K0553, K0554, K0555, L0960, L1855, L1858, L1870, L1880, L3800, L3805, L3810, L3815, L3820, L3825, L3830, L3835, L3840, L3845, L3850, L3860, L3907, L3910, L3916, L3916, L3918, L3920, L3922, L3924, L3926, L3928, L3930, L3932, L3934, L3936, L3938, L3940, L3942, L3944, L3946, L3948, L3950, L3952, L3954, L3985, and L3986.
Codes deleted in 2007 have been removed from the 2008 fee schedule. To locate these codes, please see the DME link to past fee schedules listed below in archives.
Diagnosis codes are required for processing your claims. Monitoring of this will be conducted randomly during the year. If your provider is selected for monitoring, a letter will be sent by DMS detailing the information to be returned for review.
Reimbursement for Suplena has been increased to $2.07/can effective 12/1/07.
Oxygen reimbursement for E0424, E0439, E1390, and E1391 has been set for 2008. The monthly rental amount will be $199.28.
Vivonex Plus reimbursement has been increased to $12.59 per individual packet.
A6534 has been added to the DME fee schedule with prior authorization required and manual pricing.
The following codes have had rates set: E0171, E0500, E0762, E1014, L3806, L3925, L3929, L3931 and L5964.
The following codes have had rate adjustments: A7032, A7034, A7044, B4083, E0570, E0675, E0981, L0468, L3332, L3763, L3923, L4386, L6611 and L6805.